Evaluation of the organisation and effectiveness of internal audits to govern patient safety in hospitals: a mixed-methods study

Abstract

ObjectivesHospital boards are legally responsible for safe healthcare. They need tools to assist them in their task of governing patient safety. Almost every Dutch hospital performs internal audits, but the effectiveness of these audits for hospital governance has never been evaluated. The aim of this study is to evaluate the organisation of internal audits and their effectiveness for hospitals boards to govern patient safety.Design and settingA mixed-methods study consisting of a questionnaire regarding the organisation of internal audits among all Dutch hospitals (n=89) and interviews with stakeholders regarding the audit process and experienced effectiveness of audits within six hospitals.ResultsResponse rate of the questionnaire was 76% and 43 interviews were held. In every responding hospital, the internal audits followed the plan–do–check–act cycle. Every hospital used interviews, document analysis and site visits as input for the internal audit. Boards stated that effective aspects of internal audits were their multidisciplinary scope, their structured and in-depth approach, the usability to monitor improvement activities and to change hospital policy and the fact that results were used in meetings with staff and boards of supervisors. The qualitative methods (interviews and site visits) used in internal audits enable the identification of soft signals such as unsafe culture or communication and collaboration problems. Reported disadvantages were the low frequency of internal audits and the absence of soft signals in the actual audit reports.ConclusionThis study shows that internal audits are regarded as effective for patient safety governance, as they help boards to identify patient safety problems, proactively steer patient safety and inform boards of supervisors on the status of patient safety. The description of the Dutch internal audits makes these audits replicable to other healthcare organisations in different settings, enabling hospital boards to complement their systems to govern patient safety.

Health boards' governance of quality and risk: quality improvement agenda for the board

“…A growing body of the literature reports on research related to successful initiatives that health boards can undertake in relation to quality and risk management. These include: identification and implementation of specific competencies for board members; accountability and performance assessments for board members and their chief executives; the promulgation of culture and engagement focused towards quality; and the development of strategies, policies and system delivery structures focused on quality, risk and safety that are measurable and subject to audit (Leggat and Balding, 2019;Szekendi et al, 2015, Van Gelderen et al, 2017. Operational, cultural and environmental conditions and changes to quality and risk management can mean compromise and failure in service and care delivery.…”

Evaluation of Safety Climate and Service Performance of Inpatient Care Unit of Public Hospital

“…Safety climate in an organization is very important, because it determines the productivity of an organization 1 . The hospital unit as a health organization that organizes health services consisting of inpatient, outpatient and emergency services must pay attention to the safety climate as a guarantee of the safety and health of the workers and patients.…”

Effects of patient safety auditing in hospital care: results of a mixed-method evaluation (part 1)

“…Interventions regarding patient safety that aim to intervene at an organizational level and that actively engage workers in preventing patient safety risks are presented as promising solutions [6]. In the Netherlands, almost all hospitals have implemented internal auditing to monitor and improve patient safety in hospital care [7]. We defined internal auditing as an independent, objective assurance activity that uses a peer-to-peer evaluation approach to engage healthcare professionals in the plan-do-check-act (PDCA) quality improvement cycle [8].…”